Attorney Data Form CJA-5 - Official Federal Forms

ATTORNEY DATA FORM Please complete this form and return it with your CJA voucher to: United States Court of Appeals for the Tenth Circuit, Office of the Clerk, Byron White United States Courthouse, 1823 Stout Street, Denver, Colorado 80257 Social Security Number: Name and Mailing Address: Telephone Number: Email Address: Indicate below your choice of how payments should be reported to the IRS: Under my Social Security Number and Name, as indicated above; or To the law firm with which I am affiliated. I have provided my Social Security Number as indicated above and the Law Firm's Taxpayer Identification Number, Name and Address are: Taxpayer Identification Number of Law Firm (required if affiliated with a firm) Name of Law Firm Address of Law Firm City: Zip Code: State: AL Signature: Date: CJA-5 12/07 American LegalNet, Inc. www.FormsWorkflow.com